When I first started assisting with these blocks , in the late 60's we often used marcaine . Marcaine/bupivicaine was the juice of the time ! Several hospitals later , now in a busy DGH in east anglia , I once spent an entire shift(icy January ) down in A&E doing nothing but Bier block Colles . In this hospital we always used a double cuff tourniquet specially designed and made for Biers . Around this time I started palpating brachial pulse and slowly inflating the cuff until the pulse was occluded . Found this worked very well and gave a real and accurate indication of how to set the cuff pressure .
Using Marcaine is not recommended for the Bier Block! (0:44) If the tourniquet should fail, the patient will die. This is well documented in the literature. Well documented.
- placement of IV should be distal as this helps with spread of the IV lidocaine in the extremity - double tourniquet is crucial, and should be checked and double checked before initiating the procedure. it makes sense to inflate the proximal cuff first. as tourniquet pain sets in then inflate the distal cuff and release the proximal cuff to give a additional minutes of time. - should use prilocaine or lidocaine for the procedure. would strongly advise against use of bupivicaine or ropivicaine due to potential toxicity from inadvertent tourniquet release
Actually, you should inflate the proximal cuff first, unlike it is shown in this video. This video is totally missing on the point of two tourniquets. You inflate proximal tourniquet first. Let analgesia to set in. When tourniquet pain starts bothering the patient - and it happens soon if you inflate at 250 mmHg - you inflate the distal tourniquet!!! - and let go of the proximal one. That way your second tourniquet is applied to already anesthetized portion of the extremity and is tolerated much better, and buys you more time. And you release your local anesthetic more gradually that way - some (small) portion of your dose will be released when you let go of the proximal tourniquet.
Thank you for pointing it out! i have an exam tomorrow and just thought WTF(!) watching this hahaha Thought i had better read the comments as it goes against what i have been taught.
Hоw I Cured Му CаndidaLife-lоng Sufferеr DiscоvеrsРоwerful Seсrеt To Yeeеast Infection Frеedomtwitter.com/480c938a3c34c4b8e/status/784262969735516160 Bier Bloсk
I had this done about 4 years ago to my right wrist. I only felt them tugging at it and some pressure and a lot of heat. The people at Arkansas Childrens Hospital did me right.
If we put the distal cuff below elbow does it effectively stop arterial circulation?and how painful is applying the esmarch bandage in a # patient before any LA is applied?
+DoctorJay2012 Easier for who? This way the patient is not in pain and can remain awake and clear-headed, no recovery period needed, and the potential adverse effects of sedation can be avoided.
Lowest dose of lidocaine at which cardiac arrest reported in the literature is 2.5 mg/kg. Seizure has occurred at 1.5 mg/kg. Tourniquet failure is the greatest risk.
.. maximum dose you said is very high .2-2.5 mg per kg is max dose volume 30-40 ml There are simple brachial plexus blocks that can provide excelent analgesia and also avoid LAST Always have LAST kit ready Irrespective of duration of procedure the tourniquest should be placed inflated for 30 mins min Serial deflation is the rule before complete deflation Observation of patient post procedure is must . With the advancement of current USG guided techniques this block is just a gateway to death
When I first started assisting with these blocks , in the late 60's we often used marcaine . Marcaine/bupivicaine was the juice of the time ! Several hospitals later , now in a busy DGH in east anglia , I once spent an entire shift(icy January ) down in A&E doing nothing but Bier block Colles . In this hospital we always used a double cuff tourniquet specially designed and made for Biers . Around this time I started palpating brachial pulse and slowly inflating the cuff until the pulse was occluded . Found this worked very well and gave a real and accurate indication of how to set the cuff pressure .
Using Marcaine is not recommended for the Bier Block! (0:44) If the tourniquet should fail, the patient will die. This is well documented in the literature. Well documented.
agree
Yes! Bupivacaine(marcaine) should never be given intravenously. Never!
thank you. was very easy to understand the explanation.
Prilocaine is the best agent, also carry lipid rescue (intralipid) for la toxicity!
philip argy...agree most clinicians use prilocaine these days...while 0.5% of lidocaine can also be used but marcaine never...
- placement of IV should be distal as this helps with spread of the IV lidocaine in the extremity
- double tourniquet is crucial, and should be checked and double checked before initiating the procedure. it makes sense to inflate the proximal cuff first. as tourniquet pain sets in then inflate the distal cuff and release the proximal cuff to give a additional minutes of time.
- should use prilocaine or lidocaine for the procedure. would strongly advise against use of bupivicaine or ropivicaine due to potential toxicity from inadvertent tourniquet release
Actually, you should inflate the proximal cuff first, unlike it is shown in this video. This video is totally missing on the point of two tourniquets.
You inflate proximal tourniquet first. Let analgesia to set in. When tourniquet pain starts bothering the patient - and it happens soon if you inflate at 250 mmHg - you inflate the distal tourniquet!!! - and let go of the proximal one. That way your second tourniquet is applied to already anesthetized portion of the extremity and is tolerated much better, and buys you more time. And you release your local anesthetic more gradually that way - some (small) portion of your dose will be released when you let go of the proximal tourniquet.
dude you can't use marcaine for a bier block.
Thank you for pointing it out! i have an exam tomorrow and just thought WTF(!) watching this hahaha
Thought i had better read the comments as it goes against what i have been taught.
Hоw I Cured Му CаndidaLife-lоng Sufferеr DiscоvеrsРоwerful Seсrеt To Yeeеast Infection Frеedomtwitter.com/480c938a3c34c4b8e/status/784262969735516160 Bier Bloсk
I had this done about 4 years ago to my right wrist. I only felt them tugging at it and some pressure and a lot of heat. The people at Arkansas Childrens Hospital did me right.
If we put the distal cuff below elbow does it effectively stop arterial circulation?and how painful is applying the esmarch bandage in a # patient before any LA is applied?
Great educational video. Thank you
in india we use vocal anaesthesia
Hey how does that work
wow great video. everything was step by step. thank u dr
Hi friend
how about prilocain?
What will happen if it’s premature released?????????
we use 30-60ml of 0.5% lignocaine in SA aswell
H
Awesome skills, but I feel like a bit of ketamine/propofol along with a hematoma block would be easier. Excellent video however.
+DoctorJay2012 Easier for who? This way the patient is not in pain and can remain awake and clear-headed, no recovery period needed, and the potential adverse effects of sedation can be avoided.
I had a Bier block and I was put under completely. I think that was better for me.
@@kishalashawn5542 Do you mean you had IV sedation along with the BB? You wouldn't need the BB with general anesthesia, only the tourniquet.
Lowest dose of lidocaine at which cardiac arrest reported in the literature is 2.5 mg/kg. Seizure has occurred at 1.5 mg/kg. Tourniquet failure is the greatest risk.
Thank you very much.
.. maximum dose you said is very high .2-2.5 mg per kg is max dose
volume 30-40 ml
There are simple brachial plexus blocks that can provide excelent analgesia and also avoid LAST
Always have LAST kit ready
Irrespective of duration of procedure the tourniquest should be placed inflated for 30 mins min
Serial deflation is the rule before complete deflation
Observation of patient post procedure is must
. With the advancement of current USG guided techniques this block is just a gateway to death
Слишком хлопотная техника,я пользуюсь внутри костным введением анестетика,непосредственно в место перелома.
Bupivacaine is contraindicated
Sorry you can't use bupivacine
👍🧡
Yes.